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WO2005025477A2 - Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation - Google Patents

Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation Download PDF

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Publication number
WO2005025477A2
WO2005025477A2 PCT/US2004/028522 US2004028522W WO2005025477A2 WO 2005025477 A2 WO2005025477 A2 WO 2005025477A2 US 2004028522 W US2004028522 W US 2004028522W WO 2005025477 A2 WO2005025477 A2 WO 2005025477A2
Authority
WO
WIPO (PCT)
Prior art keywords
port
patient
conduit
inhalation
exsufflation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2004/028522
Other languages
English (en)
Other versions
WO2005025477A3 (fr
Inventor
George P. Emerson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
J H Emerson Co
Original Assignee
J H Emerson Co
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by J H Emerson Co filed Critical J H Emerson Co
Priority to AT04782919T priority Critical patent/ATE539787T1/de
Priority to JP2006525428A priority patent/JP4617308B2/ja
Priority to AU2004271999A priority patent/AU2004271999B2/en
Priority to CA2537353A priority patent/CA2537353C/fr
Priority to EP04782919A priority patent/EP1663361B1/fr
Publication of WO2005025477A2 publication Critical patent/WO2005025477A2/fr
Publication of WO2005025477A3 publication Critical patent/WO2005025477A3/fr
Priority to IL174058A priority patent/IL174058A/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A61M16/201—Controlled valves
    • A61M16/202—Controlled valves electrically actuated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M16/0006—Accessories therefor, e.g. sensors, vibrators, negative pressure with means for creating vibrations in patients' airways
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M16/0009—Accessories therefor, e.g. sensors, vibrators, negative pressure with sub-atmospheric pressure, e.g. during expiration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0057—Pumps therefor
    • A61M16/0066—Blowers or centrifugal pumps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816—Joints or connectors
    • A61M16/0841—Joints or connectors for sampling
    • A61M16/0858—Pressure sampling ports
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/105—Filters
    • A61M16/1055—Filters bacterial
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/105—Filters
    • A61M16/106—Filters in a path
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0015—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
    • A61M2016/0018—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
    • A61M2016/0024—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with an on-off output signal, e.g. from a switch
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter

Definitions

  • This invention relates to an improved insufflation-exsufflation system with automatic triggering of inhalation phase.
  • MI-E mechanical insufflation and exsufflation
  • SMA spinal muscular atrophy
  • ALS amyotropic lateral sclerosis
  • the technique involves the use of a blower and valve, which, via a facemask, mouthpiece or adapter for a tracheal tube, alternately applies positive pressure first to inflate the lungs, then shifts rapidly to negative pressure to create a high expiratory flow.
  • the internal valve executes a sequence of pressures applied to the patient's airway: first positive pressure to inflate the lungs, then a shift to negative pressure to create a high exhalation flow. This sequence is typically repeated a number of times (anywhere from 2 to 6) in succession for a treatment. TTie timing of each phase is adjustable by the user. Also, the initiation of the sequence is begun by the user actuating a switch.
  • the user may also initiate each phase by actuating a switch while in a manual mode.
  • a switch One shortcoming of current MI-E devices is that the beginning of an inhalation phase (positive pressure to first inflate the lungs) is triggered by either the patient or the patient's caregiver actuating a switch to begin the cycling. If the sequence is begun while the patient is exhaling, or the patient is not ready for an inhalation from the de-vice, the patient may find the first inhalation uncomfortable, and may even unconsciously block the flow of air into the lungs. This can limit the effectiveness of the treatment-, since a full deep inhalation breath is necessary to achieve adequate exhalation flow.
  • a caregiver must "coach” the patient during a treatment, explan ing when to inhale, to avoid this problem.
  • the caregiver watches the patient's respiration in order to switch on the cycling when the patient begins to inhale.
  • Anotrier shortcoming of the current device is that it is difficult to use on very young pediatric patients, and on unconscious or uncooperative patients, where it is difficult to explain to the patient when to begin an inhalation.
  • Assist modes have been used on positive pressure ventilators, which "breathe" a patient by applying a positive pressure to the airway, usually via an endotracheal or tracheostomy tube. Such assist modes also detect the patient's inspiratory effort in. order to trigger the delivery of a breath by the ventilator.
  • CPAP Continuous Positive Airway Pressure
  • next negative pressure or flow sensed wtien the patient again inhales can be used to trigger delivery of the next positive pressure, i contrast in insufflation-exsufflation systems after the inhale/positive pressure comes the exhale negative pressure.
  • the system will return to the positive pressure but on the basis of the existing negative pressure which may not be the negative pressure created by a patient inhalation, thereby losing synchronism with the normal breathing of the patient.
  • the invention results from the realization that an improved insufflation- exsufflation system for removal of broncho-pulmonary secretions with automatic triggering of inhalation phase can be effected by selectively connecting a patients breathing conduit to a positive pressure port, a negative pressure port and a dwell port, only after an inhalation of the patient has been sensed while the conduit is connected to the dwell port.
  • This invention features an improved insufflation-exsufflation system for removal of broncho-pulmonary secretions with automatic triggering of the inhalation phase.
  • a switching device selectively connects the conduit to the positive pressure port, the negative pressure port and a dwell port.
  • a sensor system senses an inhalation by the patient.
  • a controller system drives the switching device to connect the conduit sequentially to the positive port, the negative port and the dwell port and to return again to the positive port in response to the sensor system sensing an inhalation by the patient while the conduit is connected to the dwell port.
  • the switching device may include a selector valve or valves and an actuator device.
  • the sensor system may include a pressure sensor in the conduit or an airflow detector.
  • the controller system may include a programmed timer.
  • Fig. 1 is a schematic block diagram of an insufflation-exsufflation system according to this invention.
  • Figs. 2 and 3 are schematic diagrams showing alternative connections of the system to a patient's airway.
  • Fig. 4 shows an alternative embodiment of a sensor system employing a flow sensor
  • Fig. 5 is a more detailed schematic diagram of the positive/negative pressure source of Fig 1;
  • Fig. 6 is a schematic diagram showing in more detail the program timer of Fig. 5.
  • FIG. 1 an improved insufflation-exsufflation system 10 according to this invention, including a positive/negative pressure source 12 and a conduit 14 through which it provides the positive and negative pressure to patient 16 through, for example, a face mask 18.
  • conduit 14, Fig. 2 maybe connected directly to a tracheostomy tube 20 or as shown in Fig. 3, to an endotracheal tube 22.
  • a bacterial filter 24 may be employed in various location in conduit 14.
  • a pressure transducer or pressure switch 26 may be employed to sense the pressure in conduit 14. When it senses a slight negative pressure indicative of an inhalation it provides a signal to pressure source 12 to provide the positive pressure flow to assist in the inhalation by the patient 16 and provides a signal over line 28.
  • pressure transducer or pressure switch 26 may be replaced by a flow sensor 26a, Fig. 4, or any other suitable device which can sense the beginning of an inhalation by patient 16, for example, electrodes, strain gauges, or chest strap devices may be put on or around the patient's body or chest cavity to sense the beginning of an inhalation independent of the actual airflow characteristics in the airway of the patient.
  • Dwell port 40 is provided for connection to ambient or atmospheric pressure, and may also include a flow restrictor 41 to make the sensor 2.6 more sensitive when it is, for example, a pressure sensor or pressure switch.
  • Programmed timer 42, Fig. 5 drives actuator device or actuator motor 44 which through eccentric drive 46 moves swinger 48 of slider valve 50 from positive port 34 to negative port 38, then to dwell port 40.
  • Swinger 48 remains there until sensor 26 senses that a patient inhalation has begun, at which point it sends a signal on line 28 to program timer 42 to once again operate actuator motor 44 to move slider switch 50 through the cycle of positive port 34, negative port 38 and dwell port 40.
  • Programmed timer 42 may include a timer 60, Fig. 6, which operates driver circuit 62 that causes actuator motor 44 to step through the three positions of swinger 48: positive port 34, negative port 38, and dwell port 40.
  • An alternate output 59 of the timer 60 indicates when the driver 62 is holding the swinger 48 at the dwell port 40, and provides one input to AND gate 66.
  • pressure sensor 26 senses that a patient inhalation is beginning it also provides an input to AND gate 66.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Medicines Containing Material From Animals Or Micro-Organisms (AREA)
  • Endoscopes (AREA)
  • Percussion Or Vibration Massage (AREA)

Abstract

L'invention concerne un système d'insufflation/exsufflation amélioré destiné à éliminer les sécrétions broncho-pulmonaires avec déclenchement automatique de la phase d'inhalation. Ce système comprend un conduit destiné à être raccordé aux voies respiratoires d'un patient, une source de pression pourvue d'un orifice de pression positive et d'un orifice de pression négative, un dispositif de raccordement permettant de raccorder sélectivement le conduit à l'orifice de pression positive, à l'orifice de pression négative et à un orifice de pression atmosphérique, un système de détection destiné à détecter une inhalation du patient, ainsi qu'un système de commande servant à commander le dispositif de raccordement et permettant de raccorder successivement les conduits à l'orifice de pression positive, à l'orifice de pression négative et à l'orifice de pression atmosphérique, et de revenir à l'orifice de pression positive en réponse à la détection d'une inhalation du patient par le système de détection pendant que le conduit est raccordé à l'orifice de pression atmosphérique.
PCT/US2004/028522 2003-09-08 2004-09-02 Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation Ceased WO2005025477A2 (fr)

Priority Applications (6)

Application Number Priority Date Filing Date Title
AT04782919T ATE539787T1 (de) 2003-09-08 2004-09-02 Insufflations-exsufflationssystem zur entfernung von bronchopulmonalsekret mit automatischer auslösung der inhalationsphase
JP2006525428A JP4617308B2 (ja) 2003-09-08 2004-09-02 吸入段階を自動的に起動させる気管支肺分泌物を除去するための吸気／呼気システム
AU2004271999A AU2004271999B2 (en) 2003-09-08 2004-09-02 Insufflation-exsufflation system for removal of pulmonary secretions
CA2537353A CA2537353C (fr) 2003-09-08 2004-09-02 Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation
EP04782919A EP1663361B1 (fr) 2003-09-08 2004-09-02 Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation
IL174058A IL174058A (en) 2003-09-08 2006-03-02 Insufflation-exsufflation system for removal of broncho-pulmonary secretions with automatic triggering of inhalation phase

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/657,405 2003-09-08
US10/657,405 US6860265B1 (en) 2003-09-08 2003-09-08 Insufflation-exsufflation system for removal of broncho-pulmonary secretions with automatic triggering of inhalation phase

Publications (2)

Publication Number Publication Date
WO2005025477A2 true WO2005025477A2 (fr) 2005-03-24
WO2005025477A3 WO2005025477A3 (fr) 2005-10-06

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2004/028522 Ceased WO2005025477A2 (fr) 2003-09-08 2004-09-02 Systeme d'insufflation/exsufflation destine a eliminer les secretions broncho-pulmonaires avec declenchement automatique de la phase d'inhalation

Country Status (9)

Country Link
US (1) US6860265B1 (fr)
EP (1) EP1663361B1 (fr)
JP (1) JP4617308B2 (fr)
CN (1) CN100512899C (fr)
AT (1) ATE539787T1 (fr)
AU (1) AU2004271999B2 (fr)
CA (1) CA2537353C (fr)
IL (1) IL174058A (fr)
WO (1) WO2005025477A2 (fr)

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CN1849149A (zh) 2006-10-18
US20050039749A1 (en) 2005-02-24
EP1663361A4 (fr) 2010-12-01
JP2007504859A (ja) 2007-03-08
EP1663361A2 (fr) 2006-06-07
AU2004271999A1 (en) 2005-03-24
CA2537353A1 (fr) 2005-03-24
CA2537353C (fr) 2010-11-23
IL174058A (en) 2010-03-28
EP1663361B1 (fr) 2012-01-04
JP4617308B2 (ja) 2011-01-26
US6860265B1 (en) 2005-03-01
CN100512899C (zh) 2009-07-15
IL174058A0 (en) 2006-08-01
AU2004271999B2 (en) 2008-02-07
ATE539787T1 (de) 2012-01-15
WO2005025477A3 (fr) 2005-10-06

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